Familial prostate cancer: the damage done and lessons learnt

Abstract

Background A 51-year-old French Canadian man commenced screening for prostate cancer at the request of his family physician given his extensive family history of prostate cancer in five brothers, his father and two paternal uncles. His prostate specific antigen (PSA) level was 4.9ng/ml and a subsequent six-core biopsy revealed the presence of a prostate adenocarcinoma with a Gleason score of 7 (3+4). He was treated with a radical prostatectomy. Repeat PSA tests revealed a gradual rise in PSA levels despite androgen deprivation therapy with bicalutamide and goserelin over the course of 3 years. Genetic evaluation was undertaken in view of his personal and family history. The proband died a year later of widespread metastasis, at the age of 58. Investigations Doppler ultrasound for the proband’s leg, abdominal and pelvic computed tomography (CT) scan with intravenous (IV) and oral contrast as well as chest CT with IV contrast for the assessment of metastatic prostate cancer; genetic counselling and mutation analysis for French Canadian founder mutations in the BRCA1 and BRCA2 genes; mutations specific analysis of the mother’s formalin-fixed, paraffin-embedded (FFPE) breast tissue blocks; examination of loss of heterozygosity at the BRCA2 gene locus; immunohistochemistry to determine the expression of the ERG nuclear oncoprotein in prostate tumours; genotyping with eight selected risk-associated single nucleotide polymorphisms (SNPs); genetic testing for the G84E variant in the HOXB13 gene Diagnosis Early-onset and aggressive prostate cancer associated with a missense French Canadian BRCA2 founder mutation, c.5857G>T (p.Glu1953*). Management Radical prostatectomy, hormone therapy with bicalutamide and goserelin, palliative chemotherapy initially with docetaxel plus prednisone then with mitoxantrone plus prednisone, as well as genetic counselling and testing for the proband and his family members.

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Preventing and Correcting Communicable and Non-Communicable Chronic Disease via Amlexanox – Dual ‘No-Nonsense’ and Inflammatory Axis Targeting

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